Chapter 11
Health and Nutrition
It is unarguably true that health and nutrition
make important contribution to economic
development. Healthy people are more lively,
energetic and effectively contribute in
economic progress, whereas, malnutrition, ill-
health and diseases are considered as barriers to
economic growth. Delivering better health
services has continuously been the prime
objective of the government. Pakistan has a mix
of public and private health service delivery
system. Under 18th Constitutional Amendment,
health service delivery has been transferred to
the provinces, though, Pakistan Vision 2025,
which was prepared in consultation with
provinces provide a road map which includes
reducing the widespread prevalence of
communicable diseases, disease surveillance,
addressing inadequacies in primary/secondary
health care facilities, correcting rural/urban
biases, bridging basic nutritional gaps and
improving the pharmaceutical sector to ensure
the availability, affordability and quality of
medication drugs. An inter-sectoral cooperation
and sector wide approaches are required to
achieve the pioneering goals in the years ahead
for which, there is a dire need to increase
resource allocation, strengthening primary
health care services and motivating the human
resources employed in health sector by good
governance. The country’s ownership of the
SDGs would be a prerequisite for health and
development in future.
Table 11.1: Health & Nutrition Expenditures
Fiscal Years Public Sector Expenditure
(Federal and Provincial)
Total Health Development
Expenditures Expenditure
2007-08 59.90 27.23
2008-09 73.80 32.70
2009-10 78.86 37.86
2010-11 42.09 18.71
2011-12 55.12 26.25
Health Expenditure
Cumulative health expenditures of federal and
the provinces are estimated at Rs 384.57 billion
for fiscal year 2017-18 which is 31.75 percent
higher than the actual expenditures of Rs
291.90 billion realized during fiscal year 2016-
17. A brief look into previous year’s
performance reveals that total health
expenditures increased both in terms of growth
and as percentage of GDP. It grew by 29.54
percent to stand at Rs 291.90 billion during
fiscal year 2016-17 against Rs 225.87 billion in
2015-16. Encouragingly, health expenditures
surpassed the budget allocation of Rs 273.34
billion set for 2016-17.
While in terms of GDP, health expenditure
increased to 0.91 percent during fiscal year
2016-17 from 0.77 recorded in 2015-16.
During the months of Jul-February, 2017-18
health expenditures consumed 43.5 percent of
budget allocation to reach Rs 167.16 billion
against the expenditure of
Rs 121.57 billion in the comparable period of
fiscal year 2016-17. In terms of growth it
increased by 37.51 percent. Viewed from GDP,
it increased to 0.49 percent during July-
February, 2017-18 from 0.38 percent recorded
in the same period of fiscal year 2016-17.
(Rs billion)
Percentage Health
Change Expenditure as
Current % of GDP
Expenditure
32.67 19.80 0.56
41.10 23.21 0.56
41.00 6.86 0.53
23.38 -46.63 0.23
28.87 30.96 0.27
Pakistan Economic Survey 2017-18
201
Table 11.1: Health & Nutrition Expenditures
Expenditu (Rs billion)
Fiscal Years Public Sector Expenditure Percentage Health
(Federal and Provincial) Change Expenditure as
Total Health Development Current % of GDP
Expenditures Expenditure Expenditure
2012-13 125.96 33.47 92.49 128.51 0.56
2013-14 173.42 58.74 114.68 37.68 0.69
2014-15 199.32 69.13 130.19 14.94 0.73
2015-16 225.87 78.50 147.37 13.32 0.77
2016-17 291.90 101.73 190.17 29.54 0.91
2017-18 B.E 384.57 130.19 254.38 31.75 1.12
Jul-Feb
2016-17* 121.57 30.40 91.17 - 0.38
2017-18* 167.16 40.66 126.50 37.51 0.49
*Expenditure figure for the respective years are for the period (July-Feb)
(July
Source: Finance Division (PF Wing)

It is worth mentioning that the current fiscal 384.57 billion during fiscal year 2017
2017-18
year has witnessed a considerable increase in compared with Rs 273.34 billion during
du fiscal
budget allocation for health expenditures year 2016-17
17 (Table 11.2).
showing 40.7 percent growth by allocating Rs

Table 11.2: Budget Allocation Health (2015-16

(2015 to 2017-18) (Rs million)
Current Expenditure Development Expenditure Total
2015-16 2016-17
2016 2017-18 2015-16 2016-17 2017-18 2015-16
2015 2016-17 2017-18
Punjab 61,762 70,060 111,026 29,295 31,774 42,149 91,057 101,834 153,175
Sindh 54,091 61,760 85,304 12,413 15,000 15,431 66,504 76,760 100,735
Khyber 16,701 19,775 26,898 12,782 16,362 15,543 29,483 36,137 42,441
Pakhtunkhwa
Balochistan 15,482 17,368 18,307 3,840 3,536 6,013 19,322 20,904 24,320
Federal 12,108 12,379 12,847 25,874 25,324 51,051 37,982 37,703 63,898
Total 160,144 181,342 254,382 84,204 91,996 130,187 244,348 273,338 384,569
Annual Budget Statement 2017-18
18
Source: PF Wing (Finance Division)

Fig 11.1: Health Expenditure as % of GDP

0.91

1.0
0.77
0.73

0.9
0.69

0.8
0.56

0.56

0.56
0.53

0.7
0.49
percent age

0.6
0.5
0.27
0.23

0.4
0.3
0.2
0.1
0.0
2007-08 2008-09 2009-10
2009 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
16 2016-17 2017-18
(Jul-Feb)
Source: PF Wing (Finance Divsion)

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 Health and Nutrition

Fig-11.2:
11.2: Total Public Sector Expenditure on Health

200
Pak Rs (billion)

150

100

50

0
2017-18
2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015--16 2016-17
(Jul-Feb)
Development 27.2 32.7 37.9 18.7 26.3 33.5 58.7 69.1 78.1 101.7 40.7
Current 32.7 41.1 41.0 23.4 28.9 92.5 114.7 130.2 147.3 190.2 126.5
Total 59.9 73.8 78.9 42.1 55.1 126.0 173.4 199.3 225.3 291.9 167.2

Source: PF Wing (Finance Divsion)

According to the break-up up of federal and in Punjab (84.8 percent) followed by Sindh
provincial share in total public spending on (41.4), Khyber Pakhtunkhwa (17.6 percent) and
health during July-February,
February, 2017-18,
2017 the major Balochistan (11.3 percent) (see Fig
Fig-11.3).
share of spending on health has been observed

Fig-11.3:
11.3: Share in Total Public Sector Health Expenditure
140
120 Federal Punjab
100 Sindh Khyber Pakhtunkhwa
(Rs. Billion)

80 Balochistan

60
40
20
0
2017-18
2012-13 2013-14 2014-15 2015-16 2016-17
17
(Jul-Feb)
Federal 11.4 34.7 36.2 35.3 46.9 12.1
Punjab 47.8 55.1 67.7 88.5 127.7 84.8
Sindh 43.5 46.6 51.2 61.3 62.9 41.4
Khyber Pakhtunkhwa 12.8 24.5 30.8 24.4 33.0 17.6
Balochistan 10.4 12.5 13.5 15.8 21.4 11.3

Source: Finance Division (PF Wing)

Prime Minister’s National Health mannerr without any financial obligations. The
Programme: funding for the programme is being provided by
the federal and provincial governments. A total
Prime Minister Health Programme was
amount of Rs 15.0 billion was allocated in
launched initially in 23 districts and under
PSDP 2017-18 18 for the two phases of the
Phase-II, the services
es have been expanded to 40
programme. As of 31st January 2018 mor
more than
districts to cover 14 million families. The
1,655,657 families have been enrolled in Prime
programme is a milestone towards social
Minister’s National Health Programme and
welfare reforms; ensuring that the under- under
more than 56,000 families have been treated for
privileged citizens across the country get access
various illnesses from 125 empanelled hospitals
to medical health care in a swift and dignified
across Pakistan.

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Pakistan Economic Survey 2017-18
Prime Minister’s Programme for Prevention be helpful in addressing the hepatitis issue in
and Control of Hepatitis in Pakistan: the country.
All forms of hepatitis are of concern within Polio Eradication Initiatives
public health framework. The programme
envisages meeting the challenges posed by the Through polio eradication efforts, a substantial
high prevalence of viral hepatitis in the country investment has been made in strengthening
and 50 percent reduction in new cases of health service delivery systems in Pakistan.
hepatitis B and C through advocacy and Thousands of health workers have been trained,
behavior change communication, hepatitis B hundreds of volunteers have been mobilized to
vaccination of high risk groups, establishment support immunization campaigns, and cold-
of screening, diagnosis and treatment facilities chain transport equipment has been refurbished.
in 150 teaching and DHQ hospitals, safe blood Consequently, Polio incidence has almost been
transfusion and prevention of hepatitis A and E. eradicated in Pakistan. It is evident that during
Safe Blood Transfusion project with the calendar year 2011 there were total 198 polio
technical cooperation of German Society for cases that were reduced to 8 in 2017 and during
International Cooperation (GIZ) and first quarter of 2018 only one case is observed
Kreditanstalt für Wiederaufbau (KfW) is under in Balochistan. The detail is given in the
implementation in all four provinces which will following Table;
Table 11.3: Provinces Wise Polio Cases
Province 2011 2012 2013 2014 2015 2016 2017 2018
Punjab 9 2 7 5 2 0 1 0
Sindh 33 4 10 30 12 8 2 0
Khyber Pakhtunkhwa 23 27 11 68 17 8 1 0
FATA 59 20 65 179 16 2 0 0
Balochistan 73 4 0 25 7 2 3 1
Gilgit-baltistan 1 1 0 0 0 0 1 0
Azad jammu & 0 0 0 0 0 0 0 0
kashmir
TOTAL 198 58 93 306 54 20 8 1
Source: End Polio Pakistan (www.endpolio.com.pk)

people and to reduce burden of communicable

and non-communicable diseases while vertical
Fig: 11.4 Polio Cases in Pakistan
350 programmes in health sector have been
devolved to the provinces, the funding for these
300 306
vertical programmes is still catered by the
250 Federal government.
200 198
Investment in health over years have seen
150 improvement in health facilities and health care
100 93 providers. By the year 2017, the number of
50 58 54 public sector hospitals has increased to 1,211,
20 8 1
5,508 basic health units (BHUs), 676 rural
0
health centers (RHCs) and 5,697 dispensaries.
2011 2012 2013 2014 2015 2016 2017 2018
These facilities together with 208,007 doctors,
Source: End Poilo Pakistan (www.endpolio.com.pk) 20,463 dentists and 103,777 nurses bring the
current ratio of one doctor for 957 persons,
Devolved Vertical Health Programmes 9,730 person per dentist and availability of one
A series of programmes and projects are on hospital bed for 1,580 person and shows that
track in Pakistan to improve health status of the number under each establishment is increasing.

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Table 11.4: Healthcare Facilities

Health Manpower 2011 2012 2013 2014 2015 2016 2017
Registered Doctors 152,368 160,880 167,759 175,223 184,711 195,896 208,007
Registered Dentists 11,649 12,692 13,716 15,106 16,652 18,333 20,463
Registered Nurses 77,683 82,119 86,183 90,276 94,766 99,228 103,777
Population per Doctor 1,162 1,123 1,099 1,073 1,038 997 957
Population per Dentist 15,203 14,238 13,441 12,447 11,513 10,658 9,730
Population per Bed 1,647 1,616 1,557 1,591 1,604 1,592 1,580
Source: Pakistan Bureau of Statistics

The achievements of the health sector during
2016-17 included establishment of 3,100
hospital beds, 5,000 new doctors, 500 dentists,
3,200 Nurses, 4,500 paramedics, 450
Traditional Birth Attendants and 9,000 Leady
Health Workers (LHWs). Under the National
Expanded Programme for Immunization, about
7 million children were immunized and 18
million packets of ORS were distributed during
2016-17. The target for fiscal year 2017-18 is
4,000 hospital beds, 5,000 new doctors, 700
dentists, 4,000 Nurses, 5,000 paramedics and
1,000 Traditional Birth Attendants and 8,000
LHWs. Under the preventive programme, about
8 million children will be immunized and 25
million packets of ORS will be distributed
during 2017-18.

Table 11.5 Physical Achievement 2016-17 and Targets for 2017-18 (Nos.)
2016-17 Targets
Sub Sector
Target Achievement (%) 2017-18
A. Hospital Beds 5000 3100 65 4000
B. Health Human Resource
Doctors 5000 5000 100 5,000
Dentists 500 500 100 700
Nurses 4000 3200 70 4000
Paramedics 5500 4500 90 5000
TBA/CMW 550 450 90 1000
Training of LHWs 10000 9000 90 8000
C. Preventive Programmemes
Immunization (Million children) 8 7 85 8
Oral Rehydration Salt (ORS) (million Packet) 23 18 85 25
Source: Planning Commission (health section)

The following programmes and projects are
funded through the PSDP and implemented by
the provincial and area governments.
Programme for Family Planning and
Primary Health Care (LHWs Programme)
LHWs services have visible impact on the
health status of women and children in
particular through improved hygiene, birth
spacing, iron supplementation, greater
immunization coverage and through ante-natal
and post-natal coverage of the pregnant women.
The programme has recruited more than
106,000 (LHWs). The total population covered
under this programme spread over 60 percent in
Balochistan, more than 80 percent in Punjab, 65
percent in Sindh and 60 percent in Khyber
Pakhtunkhwa. A PC-I of provincial as well as
special areas governments are in approval
process in which salary packages of the staff of
this programme have been increased through
regularization of their services in compliance to
the orders of the Honourable Supreme Court of
Pakistan. These proactive steps will definitely
lead towards greater commitment and better
health service delivery at the door steps of the

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Pakistan Economic Survey 2017-18
vulnerable people. Overarching issues of
governance and monitoring still need attention
at the district and sub-district level.
Expanded Programme for Immunization
(EPI)
EPI programme provides immunization to
children against the seven vaccine-preventable
diseases under one year of age i.e. childhood
tuberculosis, poliomyelitis, diphtheria,
pertussis, neonatal tetanus, measles and
hepatitis B. New vaccines like pentavalent
vaccine have been introduced with the help of
United Nations Children Fund (UNICEF).
During the calendar year 2017 eight million
children of 0-11 months and 6.5 million
pregnant women were immunized against 7
deadly diseases and tetanus toxoide vaccine
respectively. Though after devolution this has
become largely the responsibility of the
provincial/region governments, but Federal EPI
cell currently took the responsibility of the
procurement, coordination and technical
guidance whereas Provincial EPI cells are
largely responsible for implementation of the
programme. World Bank along with other
financial partners such as World Health
Organization (WHO) and Japanese
International Cooperation Agency (JICA) has
largely contributed for the smooth
implementation of the programme. Still the
issues of routine immunization in outreach
areas of Federally Administered Tribal Areas
(FATA) and Balochistan need consideration.
Tuberculoses (TB) Control Programme
Pakistan is ranked 6th amongst 22 high disease
burden countries of the world according to
WHO. In Pakistan, 40 percent of the burden of
disease is in the form of communicable diseases
such as Malaria and TB. Incidence of TB stands
at 231/100,000 population and prevalence of
about 300 cases per 100,000 population. The
National TB Control programme (NTP) has
achieved over 80 percent Directly Observed
Treatment System (DOTS) coverage in public
sector and in the last five years the programme
has provided care to more than half a million
TB patients. The programme is moving steadily
to achieve the global targets of 70 percent case
detection. There are areas where NTP has to
improve management, quality bacteriology
170
services, engaging all care providers through
public private partnership (PPP), inter-sectoral
collaboration and Evidence Based Planning
(EBP).
Human Immunodeficiency Virus (HIV)/
Acquired Immune Deficiency Syndrome
(AIDS) Control Programme
The number of injecting drug users has posed a
threat to increased numbers of total cases of the
disease/syndrome in Pakistan. According to
National AIDS Control Programme, the
prevalence of HIV/AIDS is considered to be as
low as 1 percent, hence, not considered a high
risk country. The focus is on behavior change
communication (BCC), services to high-risk
population groups, treatment of sexually
transmitted infections (STIs), and supply of safe
blood for transfusions and capacity building of
various stakeholders. Till date 4,500 HIV
positive cases have been reported to the AIDS
Control Programmes at federal and provincial
level. The programme is technically supported
by the UN agencies and Global Fund against
AIDS, TB and Malaria.
Maternal & Child Health Programme
Mother and Child health has been one of the
priority areas of public health in Pakistan. This
programme has been launched to improve
maternal and neonatal health services for all,
particularly the poor and the disadvantaged at
all levels of health care delivery system. It aims
to provide improved access to high quality
Mother and Child health and family planning
services, train 10,000 community midwives,
provision of comprehensive Emergency
Obstetric and Neonatal Care (EmONC) services
in basic and secondary healthcare facilities,
provision of basic EmONC services in 550
health facilities and family planning services in
all health outlets. Despite these modalities,
Pakistan has shown a modest improvement and
the Infant Mortality Rate (IMR), Child
Mortality Rate (CMR) and Under 5 Mortality
Rate (U5MR) are still very high as compared to
other countries in the region. It is envisaged that
successful implementation will improve these
indicators.
Cancer Treatment Programme:
Cancer is considered as one of the deadliest

forms of non-communicable diseases and the
numbers of cases are increasing alarmingly.
Pakistan Atomic Energy Commission’s 18
Cancer Hospitals all over the country are
providing diagnostic and treatment facilities to
cancer patients. A state of the art cancer
hospital has been approved in 2016-17 to be
constructed in Pakistan Institute of Medical
Sciences (PIMS) Islamabad to provide cancer
diagnostic and treatment facilities to the
population of ICT, AJK, FATA, GB, and
adjoining areas of Rawalpindi, Peshawar etc.
The hospital will be completed within five
years.
Provincial Initiatives in Health Sector
Punjab Health Initiative Management Company
was established to make progressive movement
towards a universal healthcare coverage model
embracing the whole and deprived segments of
population, in which the needs of the poorest
are specifically protected by the government
and ensuring the availability and quality of
essential services.
Establishment of online registration of Hepatitis
B and C diagnosed patients for provision of free
medicines was one of the important steps by the
Government of Punjab towards treatment of
rising number of Hepatitis patients. Moreover,
24/7 safe mother ambulance service was
initiated in rural areas of Punjab for transfer of
pregnant mothers to the nearest BHU or
THQ/DHQ hospital in case of complications.
Government of Khyber Pakhtunkhwa extended
its “Sehat Insaaf Card” scheme to provide
healthcare services to 15 million poor
population in the province.
Government of Sindh established its first
pediatrics telemedicine clinic in Children
Hospital, Karachi with a focus to provide round
the clock consultant services to the children.
Health Planning Systems Strengthening and
information Analysis Unit
Ministry of National Health Services,
Regulations and Coordination (M/o NHSR&C)
has established Health Planning Systems
Strengthening and Information Analysis Unit
(HPSIU) in 2016. The key objective of this unit
would be to initiate strategic reforms in health
sector to ensure universal health coverage
Health and Nutrition
which is sustained, purposeful and fundamental
in nature. Sustained in the sense that it is not a
temporary effort, and will have an enduring
impact; purposeful in the sense of emerging
from a rational, planned and evidence-based
process; and fundamental in the sense of
addressing significant, strategic dimensions of
health system. Although devolution provides a
window of opportunity, it must go beyond and
introduce far-reaching reforms in the health and
social sectors. The main scopes of the unit are:-
i. Health planning and reform
ii. Align health system strengthening activities
in the country
iii. Health information analysis and its uses
iv. Provincial support and linkages
Malaria Control Programme
Malaria is the leading communicable disease in
the country being major element causing
morbidity in Pakistan. Some districts of
Pakistan have high endemic incidence of
malaria. Efforts have been made to eradicate
malaria but still some districts require
significant attention for its eradication. 66
districts of Balochistan, FATA, Khyber
Pakhtunkhwa and Sindh shared highly malarial
endemic diseased picture having annual parasite
incidence greater than 5 per 1,000 population.
National strategic plan (2015-2020) has divided
districts in different strata’s in accordance with
extent to which they are affected. Balochistan
fell in category-I of strata that was highly
disease affected.
Details of achievements is listed below
• Successful implementation of the new
funding model grant fund worth US$ 52
million.
• Secured worth US$ 39.2 million to
implement malaria control intervention in
66 districts of Pakistan under New Funding
Request of Global Fund.
• Establishment of greater than 4000 malarial
diagnosis and treatment centers.
• Establishment of greater than 12,000
capacity building (trainings) HCPs.
• Introduction of greater than 10 million long
lasting insecticide treated bed nets.
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Pakistan Economic Survey 2017-18
• Conduction of greater than 1.5 million
advocacy and awareness programmes.
• Strengthening surveillance system:
Improved surveillance in 66+5 in (District
Medical Units) DMUs supported district.
• Conduction of monthly cluster meeting in
global fund supported districts.
• Conduction of weekly watch charts and
early warning in global fund supported
district. Arrangement of grant
implementation: global fund grant malaria
component has been arranged in 66 districts
supporting Directorate of Malaria Control
(DOMC) in 48 districts of public sector and
Toxic Inhalation Hazard (TIH) in 18
districts of private sector.
Health Insurance
Prime Minister’s Health Programme is a social
protection initiative by providing financial
protection cover to all people in phases and the
data of the Benazir Income Support Progamme
will be used. Under this programme provision
of free of cost health insurance to 3.2 million
families (in Punjab, Balochistan and FATA in
its two phases) living below poverty line of
US$2 per day to access cashless health care
services package of 0.3 million rupees per
family per year available in both public and
private sector through a health card issued by a
highly transparent mechanism. Thousand of
poor patients have been benefited from the
treatment facilities including deliveries, cardiac
surgeries, cancer and other major diseases in
the best private and government hospitals in
their districts, without spending a single rupee.
As of 31st January 2018 more than 1,655,657
families have been enrolled in Prime Minister’s
National Health Programme and more than
56,000 families have been treated for various
illnesses from 125 empanelled hospitals across
Pakistan. There is also an option of inter district
portability in the programme which enables the
enrolled beneficiaries and families to access
quality indoor hospital services from any
empanelled hospital, both in public and private
sector.
National Nutrition Programme
In Pakistan, stunting, wasting and deficiency
micronutrients are endemic issue due to dietary
172
deficiencies, poor maternal and child health and
nutrition, and high burden of morbidity.
National Nutrition Programme (NNP) 2017-18,
the largest survey has been initiated by
Nutrition Wing at the Federal level. It includes
120,000 households and district specific data. It
also includes Water, Sanitation and Hygiene
(WASH) indicators, adolescent and childhood
obesity and the process is being monitored and
supervised through national steering and
national technical committees for National
Nutrition Survey (NNS).
Some of the key achievements of the
programme are as follows.
• Development of national guidelines
targeting different components of
malnutrition
• Development of strategies for fortification,
Infant and Young Child Feeding Practices
(IYCF), IYCF communication
• Maintaining capacity building of provincial
health departments on IYCF, revised
Community Based Management of Acute
Malnutrition (CMAM) guidelines, nutrition
in emergencies, Behaviour Change
Communication (BCC) on breast feeding
• Coordination with provinces and other
relevant stakeholders for wheat flour
fortification and universal salt iodization
through National Food Agency (NFA and
Provincial Fortification Alliances (PFAs)
• Establishment of IYCF committees at
provincial level for planning and promotion
of IYCF practices including breastfeeding
• Establishment of infant feeding committees
in provinces parallel to Individual and
Family Business (IFB) for oversight
• Successful expansion of community based
management of acute malnutrition
(CMAM) for children in districts with high
burden of acute malnutrition (Emergency
intervention)
• Expansion of stunting prevention
Programmes
• Successful management of malnutrition
among mothers (going side by side with
CMAM)
• Implementation of behavior change about
infant and young child feeding practices

especially breastfeeding by Provincial DoH
• Provision of supplementation targeting
pregnant & lactating women, women of
reproductive age and adolescents
• Introduction of food fortification on larger
scale
• Establishment of stunting prevention
programme through support of UN-WFP in
Sindh, Balochistan, Khyber Pakhtunkhwa
and FATA and in AJK.
• Implementation of large stunting prevention
programme in Punjab Government.
International Health Regulations
Since 2007, Pakistan has been signatory to
International Health Regulation (IHR).
Convention with National Institute of Health
(NIH) based in Islamabad with a notified focal
person overseeing reporting. Global Health
Security Agenda (GHSA) as a framework for
IHR implementation was developed and
launched after the outbreak of Ebola in 2014-15
highlighted weaknesses in certain areas of IHR.
This led to the development of Joint External
Evaluation (JEE) tool as one of the four
components of a new framework for IHR
monitoring and evaluation in collaboration with
WHO Secretariat including GHSA.
As preparatory steps for the JEE Assessment
the M/o NHSR&C took several initiatives to
Box-I: SUSTAINABLE DEVELOPMENT GOALS (SDGs) NATIONAL FRAMEWORK
Sustainable National Priority Targets
Development
Goals
Good Health By 2030, reduce the global
and Well: maternal mortality ratio to less
Being than 70 per 100,000 live births.
Ensure By 2030, end preventable deaths Under-five mortality rate
healthy lives of newborns and children under Neonatal mortality rate
and promote 5 years of age, with all countries
well-being for aiming to reduce neonatal
all at all ages mortality to at least as low as 12
per 1,000 live births and under-5
mortality to at least as low as 25
per 1,000 live births.
By 2020, halve the number of
global deaths and injuries from
road traffic accidents
By 2030, ensure universal
access to sexual and
reproductive health-care
services, including for family
Health and Nutrition
streamline the process. These steps included re-
notification of a multi-sectorial national IHR
Taskforce; notification of national & provincial
IHR Focal Persons; and a detailed orientation
and sensitization of 120 participants (provincial
and regional) from both health & non-health
sectors. This enabled Pakistan to draw on the
experience of all relevant departments and
ministries to provide a comprehensive snapshot
of the health system via JEE Assessment.
Nutrition
The adequate intake of essential nutrients from
all food groups provide basis for good health
and nourishment otherwise malnutrition sets in.
Research studies clearly shows that
malnutrition results in poor health and
education outcomes and hinder economic
growth. Global Nutrition Report (GNR) 2017
revealed that entire world is facing a critical
nutrition situation and prevalence of
malnutrition in Pakistan also remains high.
Substantial progress has been made in nutrition
programming following globally tested
initiatives through Scaling Up Nutrition
Movement (SUN) adopting multi-sectoral
approaches. To achieve nutritional targets of
World Health Assembly & SDGs, creative,
healthy and economically vibrant population is
important factor which depends on good
nutrition.
National Priority SDG Indicator National Target
Baseline 2030
2014-15
Maternal mortality ratio 276 179
89 40
55 25
Death rate due to road traffic injuries
Proportion of women of reproductive 47% 70.50%
age (aged 15-49 years) who have their
need for family planning satisfied with
modern methods
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Pakistan Economic Survey 2017-18
201
planning, information and
education, and the integration of
reproductive health into national
strategies and Programmes.
Achieve universal health
coverage, including financial
risk protection, access to quality
essential health-care
care services
and access to safe, effective,
quality and affordable essential
medicines and vaccines for all.
Adolescent birth rate (aged 10- 14 44% Half the
years; aged 15-19 years) per 1,000 present
women in that age group value
Coverage of essential health services
(defined as the average coverage of
essential services based
on tracer interventions that include
reproductive, maternal, newborn and
child health, infectious diseases, non-
communicable diseases and service
capacity and access, among the general
and the most disadvantaged
population)
Number of people covered by health
insurance or a public health system per
1,000 population

Nutrition and Food Consumption estimates showed sustained food availability

during the year to meet the national food
I. Food Availability:
requirements. The caloric availab
availability through
Pakistan is producing enough food to satisfy the major food commodities is estimated at about
dietary needs of the population as estimated in 2,500 calories/day/person with little
the food balance sheet every year. The improvement over the previous year.
Table 11.6: Food Availability (Kg) Per Capita per Annum
Food Items 2013-14 2014-15 2015-16 2016-17
2016 2017-18 (P)
Cereals 162.3 162.2 155.1 150.6 155.4
Pulses 6.3 4.4 5.2 8.1 4.5
Sugar 32.1 32.3 32.2 33.3 29.5
Milk* (Ltr) 161.3 170.2 163.3 165.0 166.5
Meat (Beef, Mutton & Poultry) 18.9 19.3 19.8 20.4 21.4
Eggs (Dozen) 6.2 6.2 6.5 7.2 7.5
Edible Oil/Ghee (Ltr) 12.6 14.2 14.3 14.1 14.5
P: provisional * Milk availability has been revised according to FAO criteria
Source: Ministry of Planning, Development & Reforms

Fig 11.5: Availability of calories per capita per day

2505
2500
2495
2490
2485
2480
2475
2470
2465
2460
2455
2013-14 2014-15 2015-16 2016-17 2017-18
Availability of Calories per capita per day 2484 2470 2473 2485 2500

II. Cost of Food Basket:
The cost is calculated every month for the basic
food basket, providing 2,100 calories and 60
grams protein, using representative data from
Pakistan Bureau of Statistics (PBS). The food
expenditure gradually rose from Rs 2,046 in
July to Rs 2,400 in Octobe
October, 2017 and gradually

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 Health and Nutrition
decreased to Rs 2085 in March 2018. However, per month during the period starting July 2017
the average cost remains Rs 2,250 per person to March, 2018 (Figure 11.6).

Fig-11.6
11.6 Cost of Food Basket (Rs. per capita/month)

2,500

2,400

2,300

2,200

2,100

2,000

1,900

1,800

Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18

18 Feb-18 Mar-18
Cost of Food Basket 2046 2216 2366 2402 2398 2324 2234 2153 2085

Nutrition Interventions/Activities:
terventions/Activities:
The following nutrition related activities are
under way;
• PSDP 2017-1818 has allocated Rs100 million
for “National initiative for
SDGs/Nutrition”. The following two
projects have been prepared by the
Nutrition Section MPDR;
− “Nutrition Awareness and Institutional
Strengthening Programme” PCPC-I cost
Rs 1,200 million
− “Utilization of specialized nutritious
products for stunting prevention in
commercial and social safety sectors
through public private partnership” PC-
PC
II cost Rs 440 million
• Federal Nutrition Programme for ICT,
AJK, FATA and GB, one district in each
area sponsored by M/o. National Health
Services, Regulation & Coordination
(MNHSRC) is under approval process (PC
(PC-
I cost Rs 248 million)
• Pakistan Multi-Sectoral
Sectoral Nutrition Strategy
has been prepared based on provincial
multi-sectoral
sectoral nutrition strategies and is
ready for launch and implementation.
• Pakistan dietary guidelines for better
nutrition (PDGN) has been prepared to
provide nutrition information for healthy
living to the masses.
• Food Composition Table (FCT) for 350 raw
and cooked food items with 25 nutrients
based on data from 12 agro agro-ecological
zones is under preparation.
• Task force for Early Childhood
Development (ECD) has been established
and Letter of Intent (LOI) is signed with
nutrition partner to formulate National
Policy Framework.
• Pakistan Food Fortification Strategy has
been revised to take up sustained actions to
overcome micronutrient deficiencies
(hidden hunger).
− To overcome Iodine Deficiency
Disorders (IDD) Universal Salt
Iodization (USI) continued in 110
districts through public private
partnership with enhanced quality
control and quality assurance
− Food Fortification Programme has
started in 43 Oil/Ghee mills having
vitamin A&D and 123 flour mills with
Iron,, folic acid, zinc and vitamin B12 in
wheat flour, to overcome hidden
hunger.
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Pakistan Economic Survey 2017-18
− Fortification Assessment Coverage
Toolkit (FACT) survey to determine
the coverage and potential contribution
of fortified foods is being conducted in
all four provinces
• Bio-fortified wheat variety “Zincol 2016”
zinc concentrated, about 20,000 tones seed
will be provided to farmers for next crop
The provinces have been implementing
following nutrition related projects;
• Punjab;
− Health reforms Programme i.e.
Integrated Reproductive Maternal
Newborn & Child Health (IRMNCH),
(Rs 13 billion)
− Stunting Prevention Nutrition
Programme in 11 southern districts (Rs
7.0 billion)
− WASH Programme in 11 southern
districts (Rs 9.0 billion)
• Sindh;
− Nutrition Support Programme (NSP)
for nine districts (Rs 4.5 billion),
targets achievement during the year is
nearing completion/completed (CHWs
100 % trained and LHWs 87% against
55%, nutrition assistants 100% trained
on Community Based Management of
Acute Malnutrition (CMAM) and
Infant and Young Child Feeding
Practices (IYCF) against 85%).
− Saaf Suthro Sindh(SSS) Programme
(Rs 278.0 million)
− Nutrition Sensitive Agriculture” project
for (Jacobabad, Sanghar & Umerkot)
(Rs 582.0 million).
− Accelerated Action Plan (AAP) for the
reduction of stunting and malnutrition
Rs1.0 billion per year.
• Khyber Pakhtunkhwa;
− Health Integrated Reforms Programme
{Integrated Reproductive Maternal
Newborn, Child Health (IRMNCH) &
Nutrition Programme} (Rs14.11
billion), about 26 stabilization centers
and 120 Outpatient Therapeutic
176
Programme (OTPs) sites are functional
at district level.
− Stunting Prevention Rehabilitation
Integrated Nutrition Gain (SPRING)
project (Rs 796 million).
• Balochistan;
− Nutrition Programme for mothers &
children in 7 districts (Rs 1.5 billion)
about 147 OTPs established and 57,239
children under five years of age and
29,834 pregnant & lactating women
screened. About 74 personnel trained
for CMAM while for Infant young
child feeding and micronutrients
activities 221 health care providers
from People's Primary Healthcare
Initiative (PPHI) trained. Behavior
change communication strategy and
Information, Education and
Communication (IEC) material and
protocols for the Opioid Treatment
Programs (OTPs) developed and
disseminated at district level
− To establish SUN movement unit, a
PC-1 has been approved (Rs50 million)
− Multi-sectoral nutrition specific and
sensitive interventions Programme (Rs
1.5 billion).
Drug Abuse
Under the administrative control of Ministry of
Narcotic Control, a National Anti-Narcotics
Policy 2010 is being implemented in
collaboration with provincial governments and
Law Enforcing Agencies (LEAs), to address the
narcotic drug issue and to control its spread
nationally as well as internationally. The policy
has three strategies; Drug Supply Reduction,
Drug Demand Reduction and International
Cooperation which focuses on strengthening
Law Enforcement Agencies at the federal,
provincial and district level to control the flow
of drugs in Pakistan. The policy also seeks to
promote international cooperation for mutual
support and partnership against narcotics. The
Anti Narcotic Force Department (ANF) has
taken numerous initiatives to fight drug hazards
which include regular monitoring of areas
around education institutions , coordination &
 Health and Nutrition
liaison with the schools, colleges and Table 11.8: Details of Punishment Award to Culprits
universities, expansion of intelligence network (Numbers)
of ANF inside main cities, locate and hunt drug Cases Registered 563
smugglers, surprise checking by ANF Special Accused Arrested 641
Squads at all Railway Stations, Use of CCTV Total decided cases 493
cameras for effective profiling of passengers at Convicted cases 435
all airports and extension of NADRA Biometric Acquitted cases 21
Dormant/ Final order cases 37
Verification System to regional Directorates
Convicted persons 538
HQs for speedy investigations. Government of
Acquitted persons 86
Khyber Pakhtunkhwa has reserved 131 beds, Conviction rate 95%
Sindh 27, Balochistan 110 and Azad Jammu &
Source: Narcotics Control Division
Kashmir 5 beds in various hospitals for drug
addicts during the period July-Dec 2017. Area Development Projects
Various narcotic seizures were made and Being conscious of the fact that the farmers in
punishments were awarded to culprits during the poppy growing areas have to be provided
the period July-Dec 2017. Details are given in with alternative sources of income, eradication
the following Tables: of poppy cultivation and socio-economic
development through alternate development
Table 11.7: Narcotics Seized by ANF & programmes is the main objective of Area
Precursors/ Synthetic / Psychotropic Drugs Development Projects. Moreover, the area
(July- December 2017)
development strategy provides a mix of
Opium 5941.18 Kg activities and services to improve the quality of
Heroin/ Morphine 393.51 Kg rural life by introducing improved grains and
Hashish 16965.18 Kg vegetable varieties, improved breeds of
Cocaine 381.30 Kg livestock, improved varieties of grass and
Amphetamine 52.30 Kgs introduction of new farming techniques. In
Methamphetamine 23.87 Kgs addition, construction of farm to market roads,
provision of electricity, construction of
Ecstasy Tablets 44265 Nos.
irrigation channels and measures to control land
Prolozam Tabes 280 Nos. erosion have also been undertaken. Following
Acetic Anhydride (AA) 198.0 Liters area development projects are being
Source: Narcotics Control Division implemented by Ministry of Narcotics Control;

Table 11.9: Area Development Projects

S# Name of Projects Duration Estimated Cost
(Rs Million)
1 Khyber Area Development Project 01-07-2001 to 1235.530
Executed by FATA Secretariat 30-06-2018
2 Mohmand Area Development Project 01-07-2013 to 859.079
Executed by FATA Secretariat 30-06-2018
3 Bajaur Area Development Project 01-07-2013 to 911.016
Executed by FATA Secretariat 30-06-2018

Nuclear Medicine & Oncology (NM&O)
Division
Pakistan Atomic Energy Commission (PAEC)
established its first nuclear medical center in
1960 at Karachi. Since then one cancer hospital
has been established every 4-5 years. Now there
are 18 cancer hospitals Atomic Energy Cancer
Hospitals, (AECHs) situated in various cities
throughout the country, several in small cities
of the country while four others are under
consideration/construction. AECHs are
operated by skilled teams of more than 2,500
professionals, including doctors, scientists,
engineers, paramedical, technical and other
supportive staff.
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Pakistan Economic Survey 2017-18
Routine Services
The hospitals are equipped with advanced,
sophisticated, modern diagnostic / therapeutic
facilities. The contribution of PAEC through its
integrated programme in diagnosis of different
kinds of cancer and allied diseases has received
considerable acclaim in the public. Major
services provided at these hospitals are
Diagnostic and Therapeutic Nuclear Medicine,
Hormonal Assays, Radiotherapy,
Chemotherapy, Indoor/wards facilities, Breast
care clinics, Biochemistry, Ultrasonography,
Color Doppler, Diagnostic Radiology,
Histopathology, Hematology, Molecular Based
Diagnostics and Cancer Prevention and
Awareness Programmes.
Achievements
During the first half of fiscal year 2017-18,
approximate funds amounting to Rs 544.0
million were provided and utilized by the
AECHs to provide diagnosis and therapeutic
facilities to approximately 450,000 patients.
Besides taking care of patients in the reported
period, the following targets have also been
achieved:
• Provision of 4 Linear Accelerators, 7
SPECT-CT and 2 Dual Head Gamma
cameras among other equipment.
• Up-gradation of GINUM, Gujranwala
including a new diagnostic center at
Narowal (Rs 2,295 Million).
• Up-gradation of NORI Islamabad (Rs
2,987.525 Million).
• Rs 287 Million worth of equipment for
NIMRA, Jamshoro.
• Rs 150 Million worth of equipment for
NORIN, Nawabshah.
• Research work continued on various IAEA
TC/RCA Project and others in collaboration
with different international/national
organizations.
178
• Provision of teaching and training facilities
to about 500 post graduate medical students
/ fellows of universities in the field of
nuclear medicine, radiation & medical
oncology, radiology and medical physics.
• Launching of cancer awareness and
prevention/control campaign especially for
breast cancer awareness for early diagnosis
and treatment leading to better prognosis
through arranging lectures, seminars, and
workshops in remote areas, through print
and electronic media and mobile breast care
clinics.
Special Projects
PAEC, in order to provide better treatment
facilities to the patients, continued working on
the following projects:
− Establishing a cancer hospital in Gilgit
Baltistan.
− Establishing a cancer hospital in Azad
Jammu and Kashmir.
− Establishing a cancer hospital in Mardan
− Up-gradation of Bahawalpur Institute of
Nuclear Medicine & Oncology (BINO),
Bahawalpur.
− Up-gradation of Karachi Institute of
Radiotherapy and Nuclear Medicine
(KIRAN), Karachi.
Conclusion
The government is dedicated to increase the
health coverage to meet the growing demand of
increasing population. Health outcomes have
improved over the years but some critical
weakness is a shortage of equipment and staff
that continues to affect health system. There is a
dire need to expand services delivery and
address the shortfall in health related human
resources and making better use of technology.
Public private partnership need to be
encouraged and coverage of public health
programmes like TB, Malaria, Hepatitis and
other communicable diseases need to be
expanded.